Interactive Education System for Teaching Patient Care

ABSTRACT

An interactive education system for teaching patient care to a user is described. The system comprises a patient simulator; a virtual instrument for use with the patient simulator in performing patient care activities; means for sensing an interaction between the virtual instrument and the simulator, and means for providing feedback to the user regarding the interaction between the virtual instrument and the simulator. In one aspect, the system includes a maternal simulator, a fetal simulator, and a neonatal simulator.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation-in-part of U.S. Ser. No. 10/848,991,filed on May 19, 2004, which is a continuation of U.S. Ser. No.10/292,193, now U.S. Pat. No. 6,758,676, filed on Nov. 11, 2002, whichis a continuation of U.S. Ser. No. 09/684,030, now U.S. Pat. No.6,503,087, filed on Oct. 6, 2000, which is a continuation-in-part ofU.S. Ser. No. 09/640,700, now U.S. Pat. No. 6,527,558, filed Aug. 17,2000, which is a continuation-in-part of U.S. Ser. No. 09/560,949, nowU.S. Pat. No. 6,443,735, filed Apr. 28, 2000, which is acontinuation-in-part of U.S. Ser. No. 09/199,599, now U.S. Pat. No.6,193,519, filed Nov. 25, 1998, which is a continuation of U.S. Ser. No.08/643,435, now U.S. Pat. No. 5,853,292, filed May 8, 1996. The entiredisclosures of the foregoing applications are hereby incorporated byreference. Also incorporated by reference is the entire disclosure ofU.S. Ser. No. 10/721,307, filed on Nov. 25, 2003, which is acontinuation-in-part of U.S. Ser. No. 10/292,193, now U.S. Pat. No.6,758,676, filed on Nov. 11, 2002.

BACKGROUND

The present embodiment relates generally to an interactive educationsystem for teaching patient care, and more particularly to such a systemhaving virtual instruments for use with a child birthing patientsimulator in conducting patient care activity.

While it is desirable to train students in patient care protocols beforeallowing contact with real patients, textbooks and flash cards lack theimportant benefit to students attained from “hands-on” practice. Thus,patient care education has often been taught using medical instrumentsto perform patient care activity on a simulator, such as a manikin.However, one disadvantage of such a system is that medical instrumentsare often prohibitively expensive, and consequently, many users mustsettle for using a smaller variety of instruments, even at the cost of aless comprehensive educational experience. One solution to the foregoingproblem is using a set of relatively inexpensive, simulated medicalinstruments (“virtual” instruments), as taught in U.S. Pat. No.5,853,292, the entire disclosure of which is hereby incorporated byreference. Another solution is for the simulators to be compatible withreal medical instruments.

Another problem in patient care education is that the patient simulatorsused for teaching a user are generally passive. For example, in a childbirthing simulation, a user must position the simulated fetus in asimulated maternal pelvis, move it down the birth canal, birth thefetus's head, rotate the fetus approximately ninety degrees to birth theshoulders, and finally, pull out the fetus, now referred to as aneonate. While replicating the sequence of events in a real delivery,the lack of verisimilitude resulting from physical manipulation of thefetus by the user undermines an appreciation for the difficulties ofproviding patient care. In a real delivery, the fetus is inaccessible,and most activity is obscured from view, and thus prior systems fail toaddress the most challenging conditions of providing patient care duringchild birthing. Moreover, prior systems fail to simulate cervicaldilation as the fetus moves down the birth canal, thus failing to allowa student to assess the stage of delivery or construct a chart ofcervical dilation versus time to assess the progress of delivery(“Partograph”).

Further, another problem in patient care education is that often thesystems are too bulky and require too many wired connections to othercomponents, which prevents easy transportation of the simulator to otherlocations. Often systems that claim to be “portable” require moving thenumerous attached components, such as compressors and power supplies,for the simulator to be fully-functional. A solution to this problem isto make the simulators fully-functional, self-contained simulators thatcommunicate with external devices wirelessly. Therefore, what is neededis a system for an interactive education system for use in conductingpatient care training sessions that includes a more realistic simulatedpatient(s).

SUMMARY

The present embodiment provides an interactive education system forteaching patient care to a user. The system includes a maternalsimulator, a fetal simulator designed to be used both in conjunctionwith the maternal simulator and separate from the maternal simulator,and neonatal simulator designed to replace the fetal simulator inpost-birth simulations. In some embodiments, the system includessimulators that are completely tetherless. That is, the simulator isfunctional without the need for wired connections to other externalinstruments, devices, or power supplies. In such embodiments, thesimulator may communicate with other devices or instruments wirelessly.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 a is a schematic view of an illustrative embodiment of aninteractive education system.

FIG. 1 b is a schematic view of an interactive education systemaccording to another embodiment.

FIG. 2 is a schematic view of the interaction between a set of virtualinstruments and a patient simulator.

FIG. 3 a is a perspective view with a cutaway of a virtual instrument.

FIG. 3 b is a perspective view with a cutaway of a sensor.

FIG. 4 is a perspective view of an illustrative embodiment of a patientsimulator.

FIG. 5 a is a perspective view of the patient simulator of FIG. 4 withan attached cover.

FIG. 5 b is a top plan view of a control box.

FIG. 6 is a perspective view of the torso of the patient simulator ofFIG. 4.

FIG. 7 is a perspective view of FIG. 6 with the fetal portion of thepatient simulator removed.

FIG. 8 is a perspective view of a distensible cervix of the patientsimulator.

FIG. 9 is a perspective view of the exterior of the patient simulator.

FIG. 10 is a perspective view of a neonatal embodiment of a patientsimulator.

FIG. 11 is a schematic view of an illustrative use of the presentsystem.

FIGS. 12-16 are screen display views generated by a program according toone embodiment of the present system.

FIG. 17 is a perspective view of a neonatal embodiment of a patientsimulator according to one embodiment of the present disclosure.

FIG. 18 is a perspective view of various modules for use with theneonatal simulator of FIG. 17.

FIG. 19 is a perspective view of a cutaway portion of the neonatalsimulator of FIG. 17.

FIG. 20 is schematic view of an air supply system of the neonatalsimulator of FIG. 17.

FIG. 21 is a perspective view of a cutaway portion of a muffler for usewith the air supply system of FIG. 20.

FIG. 22 is a screen display view generated by a program according to oneembodiment of the present disclosure.

FIG. 23 is an output display view of simulated vital signs of theneonatal simulator of FIG. 17 according to one embodiment of the presentdisclosure.

FIG. 24 is a front view of a mechanism for securing the fetal/neonatalsimulator to the maternal simulator according to one embodiment of thepresent disclosure.

FIG. 25 is a perspective, exploded view of the mechanism of FIG. 24.

FIG. 26 is a perspective view of a portion of the mechanism of FIG. 24.

FIG. 27 is a perspective view of another portion of the mechanism ofFIG. 24.

FIG. 28 is a side view of a system for causing selective rotation of thefetal/neonatal simulator during a birthing simulation.

DETAILED DESCRIPTION

Referring to FIG. 1 a, the reference numeral 10 refers, in general, toan interactive education system for teaching patient care protocols to auser. The system 10 comprises a set of virtual instruments 12 used tosimulate medical instruments, and a simulator 14 used to simulate atleast one patient for receiving patient care activity from the user. Thevirtual instruments 12 are tangible objects, and look, feel, and operatelike real medical devices in conjunction with the simulator 14, which isunderstood to encompass a variety of forms, including a fullyarticulating and adult-sized manikin, as well as a fetus, a neonate, achild, a youth, or portion of a manikin, such as the arm, torso, head,or pelvic region.

Patient care activity received by the simulator 14 from the user, orusers, is sensed in a manner to be described, and in response to theactivity, the system 10 provides feedback to the user. It is understoodthat feedback may comprise any audio, visual, or tactile response. Acomputer 15 having a program 15 a is optionally connected to the system10, for reasons to be described.

Referring to FIG. 1 b, a system 10′ comprises the computer 15 and theprogram 15 a, wherein a software-generated set of virtual instruments12′ and a software-generated simulator 14′ is provided. Thus, thepatient care activity performed by the user comprises manipulating anicon relating to a selected software-generated virtual instrument 12′ toprovide patient care to the software-generated simulator 14′. In thisembodiment, the program 15 a uses conventional means, such as clicking amouse or voice-activated software, to monitor activity by the user, andprovides feedback in response, as will be described.

Returning to FIG. 1 a, the system 10 further comprises a communicationsinterface module (“CIM”) 16, which receives operating power from aconventional power source 18, and contains a microcontroller (“PIC”) 20.Microcontrollers are available from many vendors, such as MicrochipTechnology, Inc. (Chandler, Ariz.), and are then customized. As will bedescribed, the PIC 20 receives input signals from the user's activity,and is programmed to respond in a certain manner to provide feedback tothe user. For example, to provide audio feedback, the CIM 16additionally includes an audio chip 22 which is responsive to the PIC 20for causing a speaker 24 to produce realistic patient sounds, forexample, heart, lung, blood pressure (Korotkoff), intestinal, fetal, andthe like. A control 26 is included in the CIM 16 for adjusting thevolume of the speaker 24.

Alternatively, depending on the complexity of the desired feedback, theCIM 16 may be connected to the computer 15 and program 15 a. In oneexample of feedback, the program 15 a could be used to provide a vastlibrary, for example, of ultrasound profiles, or fetal distress monitortraces. Feedback could also be of body sounds, generated by the program15 a, and played through speakers of the computer.

The CIM 16 has a plurality of ports, collectively 28, for receivinginput signals occasioned by interaction between the virtual instruments12 and sensors 30 disposed on the simulator 14, resulting from theuser's patient care activity. It is understood that there may be morethan one PIC 20, and more than one CIM 16, to manage the input signalsthus created.

The virtual instruments 12 comprise patient care devices, for example,as shown in FIG. 2, at least one IV needle, an endotracheal (ET) tube,an electrocardiogram (ECG or EKG) monitor, a blood pressure (BP) cuff, apulse oximeter cuff, a temporary external pacer, an automatic externaldefibrillator (AED), a manual defibrillator, an ultrasound wand, avirtual stethoscope, a thermometer, and a fetal distress monitor,respectively 12 a-l. Such virtual instruments look and operate like realmedical devices. Of course, other virtual instruments are contemplated,as is the use of relatively inexpensive medical devices, such as aconventional stethoscope, a vacuum extractor, catheters, trays, IVstands, and the like.

Referring to FIG. 2, the IV needle 12 a has a selectable group ofspecific drugs and dosages, and in one embodiment is part of amedication tray with an assortment of labeled syringes for dispensingthe drugs to the simulator 14, with the effects of administrationcontrolled by the program 15 a. The ET tube 12 b is used in simulatedpatient airway management, and placed in a tracheal airway of thesimulator 14. The EKG monitor 12 c comprises a 3, 5, or 12 lead system,including a real-time trace monitor and R-wave sonic markers, and aplurality of color-coded patches for attachment to a torso of thesimulator 14. The BP cuff 12 d attaches to the simulator 14, forexample, around an arm. The pulse oximeter finger cuff 12 e attaches tothe simulator 14, for example, around a finger. The temporary externalpacer 12 f has a plurality of anterior and posterior pacer pads forattachment to the torso of the simulator 14. The pacer 12 f has controlsfor pacer rate and current, and exhibits rhythm pacing, cap time, andloss of cap time, all of which is controlled by the program 15 a. Theautomatic external defibrillator (AED) 12 g has a plurality of apex andsternum AED pads for attachment to the torso of the simulator 14. Uponselecting a software-generated shock button produced by the program 15a, the system 10 simulates defibrillation shock, with the resultantconditions controlled by the program 15 a. The manual defibrillator 12 hhas a plurality of apex and sternum defibrillator paddles for contactingthe torso of the simulator 14. Upon selecting a software-generated shockbutton, or alternatively by using a dual shock buttons associated withmanual defibrillator 12 h, the system 10 simulates defibrillation shock,with the resultant conditions controlled by the program 15 a.

Still referring to FIG. 2, the ultrasound wand 12 i interacts with thesimulator 14, such that when the wand 30 i is brought within apredetermined proximity of a predetermined anatomical area of thesimulator, the CIM 16 detects the interaction and the program 15 asupplies an ultrasound profile taken from a library of ultrasound imagesand or sounds. The program 15 a may select between normal and abnormalprofiles, requiring the user to interpret the profile and respondaccordingly. The virtual stethoscope 12 j interacts with the simulator14, such that when the stethoscope 12 j is brought within apredetermined proximity of a predetermined anatomical area of thesimulator, the CIM 16 detects the interaction and feedback is suppliedto the user, as will be explained below, with FIGS. 3 a-b. Thethermometer 12 k interacts with the simulator 14, such that when thethermometer 12 k is brought within a predetermined proximity of apredetermined anatomical area of the simulator, the CIM detects theinteraction and the program 15 a supplies a temperature reading. Thefetal distress monitor 121 (tocodynomometer) attaches to a portion ofthe simulator 14, and upon attachment, the program 15 a supplies a heartrate reading for a simulated fetus.

Each instrument has a corresponding sensor 30 a-l, as indicated bylines, collectively 36. Unless otherwise indicated, the lines 36 areschematic, and merely illustrate that the virtual instruments 12 and thesensors 30 are functionally connected to each other for providing aninteraction created by the user's patient care activity, the interactionbeing reported as an input signal to the CIM 16. It is understood thatthe sharing of such physical lines among instruments 12, or sensors 30,is contemplated as well.

Interaction between the virtual instruments 12 and the sensors 30 may beelectrical, optical, pressure differential, tactile,temperature-controlled, or wireless. Generally speaking, an electricalinteraction (which would also provide the input signal) could be createdvia a virtual instrument 12 having one node and a sensor 30 with anothernode, both of which are physically connected to the CIM 16, or by avirtual instrument with two nodes and a sensor formed of conductivematerial, or vice versa, only one of which may be physically connectedto the CIM 16. For example, the IV needle 12 a corresponds with aportion of the simulator 14 capable of accepting medications, such asthe antecubital region of an arm, which may have a sensor 30 acomprising an insulator sandwiched between two layers of conductivematerial having an appropriate thickness and weave density forpermitting the needle 12 a to pass through the cloth at a low acuteangle (e.g., 20 E). The conductive layers of the sensor 30 a areelectrically coupled to the CIM 16 via line 36 a′, such that when theneedle 12 a is correctly passed through the two conductive layers,simulating cannulation of a vein of the simulator 14, a circuit iscompleted between the layers and sensed by the CIM 16.

In another example of a method of sensing interaction, the ET tube 12 bis used in simulated patient airway management, the simulator 14 havinga head, eyes, a nose, a mouth, and a realistic airway capable ofaccepting conventional airway adjuncts, with the airway configurationadjustable to display a large tongue, an obstructed pharynx, or closedvocal cords, to increase the difficulty of the patient care activity. Inorder to confirm proper placement in the tracheal airway of thesimulator 14, an optical sensor 30 b is mounted in the wall of thetrachea of the simulator 14 and connected to the CIM 16 via line 36 b′.Correct placement of the ET tube 12 b in the trachea is confirmed whenthe tip of the ET tube interrupts the beam of the optical sensor 30 b.The sensor 30 b may also be used to determine whether a fluid haspassed.

The virtual stethoscope 12 j provides an example of a wireless method ofsensing interaction. At least one sensor 30 j is placed at an anatomicallocation on the simulator 14 where specific heart, lung (includingairway), Korotkoff, fetal, or other sounds are normally heard. Thesensor 30 j provides at least one signal which is identified by thestethoscope 12 j, thereby directing an integrated sound circuit to playa sound to the user appropriate for the anatomical location of thesensor on the simulator 14. It is understood that the sound circuit hasa stored library of body sounds corresponding to the location of theselected sensor 30 j, and that the sensor 30 j is illustrative of anynumber of similar sensors.

Referring to FIG. 3 a, in some respects, the appearance of thestethoscope 12 j resembles a standard stethoscope, having earpieces 50a-b for hearing sounds, and being connected to extenders 51 a-b, whichare joined to a bifurcated ear tube 52. Similarly, the stethoscopefurther comprises a bell tube 54, and a bell 56, preferably made ofnonferrous material. However, unlike conventional stethoscopes, anelectronic control box 58 is disposed between the ear tube 52 and thebell tube 54. The control box 58 is understood to be an appropriatelydeveloped CIM 16, physically integrated into the virtual instrument 12j, thus simplifying the system 10. A jack 64 is provided on the controlbox 58 for output to an external speaker (not depicted), so that otherusers may hear the sounds heard in the earpieces 50 a-b. This not onlyincreases the number of users who benefit from the patient careactivity, but allows an instructor to test the user's ability, andcorrect the user's technique if required. The control box 58 retains asmall power source 66, such as a battery, an acquisition circuit 68 anda sound circuit 70 (see copending U.S. application Ser. No. 09/640,700,filed Aug. 17, 2000, for circuit diagrams) for directing a small speaker72, such as is available from ADDAX Sound Company (Northbrook, Ill.), toplay a predetermined sound. The speaker 72 is disposed in the earpiece50 a, and connected to the control box 58 via a wire 72 a, allowing theuser to hear the sounds produced by the sound circuit 70. It isunderstood that a second, substantially identical speaker may bedisposed in the opposite earpiece 50 b, and also connected to thecontrol box 58. In an alternative embodiment, the speaker 72 may bedisposed in the control box 58, and sounds transmitted via conventionalear tubes to the ear pieces. The sound circuit 70 is also connected tothe jack 64 for allowing connection to an external speaker for theabove-described reasons.

A switch 74, having a number of positions, is disposed on the controlbox 58 for switching between groups of sounds, for example exemplarynormal and abnormal sounds that may be those heard in an adult, neonate,or fetus. An RF (radio frequency) signal acquisition coil 76, such as isavailable from M.C. Davis Co. (Arizona City, Ariz.), is disposed in theinterior of the bell 56 for transmitting and acquiring RF signals, aswill be explained. The acquisition coil 76 is a copper coil andcircuitry having an associated wire 76 a, which is attached to theelectronic control box 58. A polymeric disc 78 is disposed between theacquisition coil 76 and the bell 56 to decrease noise from the bell.

In other embodiments, the sounds are recreated by speakers (not shown)disposed within the manikin such that the sounds are audible without theuse of a real or virtual stethoscope. In yet other embodiments, thesounds are recreated by speakers (not shown) disposed within the manikinsuch that the sounds are audible with the use of a real stethoscope.

Referring to FIG. 3 b, the sensor 30 j is disposed beneath the skin 14 bof the simulator 14 to avoid visual detection by the user. Likewise, itis advantageous that the sensor 30 j have a minimal thickness to preventintentional or accidental detection, as some anatomical locations, forexample, intercostal spaces, must be palpated in order to be located. Inan alternative embodiment, the sensors 30 j may be affixed to an overlay(not depicted) substantially similar to the skin 14 b, thus allowing theoverlay to be placed over other simulators and models of patients,thereby converting those devices to allow them to be used with thestethoscope 12 j.

The sensor 30 j comprises an RF ID tag 80, such as is available fromMicrochip Technology, Inc. (Chandler, Ariz.) (Part No. MCRF200-I/3C00A),which may be programmed using “Developer's Tools” also sold by MicrochipTechnology, Inc. to engender a unique signal that serves to identify theparticular sensor 30 j. A coil 82, such as is available from M. C. DavisCo. (Arizona City, Ariz.), is operably connected to the tag 80. The tag80 and coil 82 are potted in RTV potting material 84, or silicon rubber,such as is available from M. C. Davis Co. (Arizona City, Ariz.), toprevent damage. Once potted, the tag 80 and coil 82 collectively form aCOB module 86 which emits a signal comprising a unique train offrequencies when interrogated.

In operation, the COB module 86 may actively broadcast the frequencies,but preferably the COB module is passive, that is, only activated wheninterrogated by the acquisition coil 76 in the stethoscope bell 56. Inthis preferred embodiment, the acquisition coil 76 delivers a carriersignal, such as a 125 kHz excitation frequency, which is received by theCOB module 86 when the bell 56 is brought within a predeterminedproximity, or acquisition distance, of the COB module. The acquisitiondistance of the bell 56, and therefore the acquisition coil 76, to theCOB module 86 is determined by the strength to noise (S/N) ratio of thecarrier signal. Thus, adjustment of the S/N ratio of the carrier signalprovides a means for controlling the precision with which the user mustplace the stethoscope bell 56 in relation to the anatomical location ofthe sensor 30 j, and therefore the COB module 86. Precise placement ofthe bell 56 on the simulator 14 by the user is rewarded with feedback,in the form of an appropriate body sound. Normally, the S/N ratio is setto require that the bell 56 be brought within approximately one-half totwo centimeters of the COB module 86 of the sensor 30 j.

In response to receiving a sufficiently strong carrier signal, the COBmodule 86 emits a train of two identifying frequencies for use in aprocess conventionally known as frequency shift keying (FSK), althoughother keying methods could be used. The acquisition coil 76 in thestethoscope bell 56 receives the emitted frequencies and relays thesignal to the acquisition circuit 68, which determines the identity ofthe sensor 30 j. As the anatomical position of each sensor 30 j is knownto the programmer, a selection of appropriate body sounds associatedwith each sensor is provided, and accessible to the sound circuit 70.Thus, by identifying the sensor 30 j, the acquisition circuit 68 directsthe sound circuit 70 to play an appropriate body sound for theanatomical position of the COB module 86, which is heard by the userthrough the speaker 72 disposed in the earpiece 50 a. It can beappreciated that to expose the user to a greater selection of sounds,more sensors 30 j could be added to the simulator 14, or each sensorcould correspond to more than one sound. As depicted, the switch 74 hasfive different positions, and includes means for switching the soundcircuit 70 between five different groups of sounds. Thus, it isunderstood that the number of switch positions corresponds to the numberof sounds that can be produced by a single sensor, i.e., with thirteensensors and five switch positions, the user could listen to up tosixty-five location-appropriate sounds, including examples of normal andabnormal sounds.

It can be appreciated that the above-described acquisition coil and COBmodule may be adapted to be used with the respective leads, paddles, orprobes (“connectors”) of the ECG monitor 12 c, the temporary externalpacer 12 f, the automatic external defibrillator (AED) 12 g, the manualdefibrillator 12 h, the ultrasound wand 12 i, and the fetal distressmonitor 12 l. If desired, the connectors may be equipped with adhesiveto temporarily hold them in place on the patient simulator. Theinteraction between the instruments' connectors and the sensors 30, assensed by the CIM 16, confirms proper placement. The hidden location ofthe sensors 30 beneath the skin of the patient simulator furtherchallenges a user's patient care skills, as well as more closelymimicking a real patient.

It is understood that the simulator 14 is designed to represent apatient and receive treatment, and as such the simulator 14 could take avariety of forms, including a fully articulating and adult-sizedobstetrics simulator, a curled fetus, an articulating fetus, multiplefetuses, or a neonate, as well as a portion of simulated patient, forexample, the torso and pelvic region.

Referring to FIGS. 4 and 5 a, in an illustrative embodiment, thesimulator 14 comprises a child birthing maternal simulator 300 and aremovable associated fetal simulator 302. The maternal simulator 300 hasa head 304, with hair 306, eyes 308 a-b, a nose 310, and a mouth 312.The head assembly contains a realistic airway (not depicted) capable ofaccepting conventional airway adjuncts. Sensors, generally denoted 30(FIG. 1 a), may be disposed on the skin of the maternal simulator (shownas stippled) and/or beneath the skin (shown in phantom). It isunderstood that in one embodiment of the maternal simulator (notdepicted), no sensors are associated with the simulator. Lines 36protrude from the torso 316 for providing electrical, pneumatic, orfluid connections, as well as for connecting the sensors 30 to the CIM16, if necessary.

In other embodiments, the maternal simulator 300 is tetherless. That is,the maternal simulator is functional without wired or tubular connectionto other devices outside of the simulator and, therefore, does not havelines 36, 325 a, and 326 b extending from the torso 316. Rather, thematernal simulator is self-contained. Thus, the maternal simulator 300can include an internal power supply, such as a rechargeable power cell,and all pneumatic and fluid connections are made to the correspondingcompressors or other devices within the maternal simulator 300. As thematernal simulator is self-contained, it is not only portable, but canbe in use while being transported between different locations. Further,in such embodiments, the maternal simulator 300 may communicate withother devices, such as the CIM 16, through wireless communication. Thus,the entire simulator system 14 can be functional up to the limits of thewireless communication. Further, in some embodiments the maternalsimulator 300 may connect to a computer or network system wireless,which then connects to the CIM 16 via a wired or wireless network,making the functional distance of the maternal simulator virtuallylimitless. Though only the maternal simulator has been described here asbeing self contained, the fetal and neonatal simulators described inmore detail below are also tetherless in some embodiments. In someembodiments, the simulators are configured to be used both un-tetheredand tethered. In some embodiments, the simulators are fully-functionalwhen used un-tethered (i.e., the simulator has the same functionalitytethered and un-tethered.)

A pair of arms 318 a-b are connected to the torso 316. At least one armcontains an IV receptacle (not depicted) capable of acceptingmedications, and sensors 30 a may be placed within the receptacle toascertain whether an IV has been started. Similarly, the arm may containa sensor 30 d for auscultation of Korotkoff sounds, as well as means formeasurement of blood pressure. A pelvic region 320 of the torso 316receives a pair of legs 322 a-b.

Referring to FIG. 5 a, a cover 324 may be attached to the torso 316 viaa plurality of snaps 324 a, although other reversible fastening means,such as hook and loop closures may be used. The cover 324 retainssensors 30, for cooperating with the ultrasound wand 12 i, fetaldistress monitor 121, and the stethoscope 12 j, or alternatively atleast one small speaker, to allow simulation of fetal heart sounds whichmay be detected by the stethoscope 12 j or a conventional stethoscope,respectively. In one embodiment, the cover 324 surrounds an open cellfoam (not depicted) connected to means for producing a vacuum.Activation of the vacuum shrinks the foam, making it feel harder, whichsimulates uterine contractions by the maternal simulator 300.Alternatively, the cover 324 may retain an air bladder and associatedline (not depicted) for pressurizing the cover, thus making it feelharder. In yet other embodiments, the cover may contain a plurality offlexible tubes (not shown) extending across the torso. The air pressurein the tubes determines the hardness. The pressure is adjusted to changethe hardness. It is understood that different levels of hardness may beproduced to simulate different levels of contraction strength, forexample, mild, moderate, and strong contractions. If connected to theCIM 16 and program 15 a, the contractions could be spaced at regularintervals, and associated data for maternal intrauterine pressure may bedisplayed by the program, as will be discussed with FIG. 14.

Returning to FIG. 4, the fetal simulator 302, has an umbilical cord 302a and placenta 302 b, and is depicted as resting upon a removable stage325 disposed inside the maternal simulator. The removable stage 325 hasa bladder (not shown), a line 325 a, and a bulb 325 b. When the bulb 325b is used to pump air into the bladder, the stage 325, and hence thefetal simulator 302, is raised relatively upwards. When covered with thecover 324 (FIG. 5 a), raising of the stage 325 allows a user to palpatethe fetal simulator 302 through the cover to assess position, as well asto perform Leopold maneuvers. In other embodiments, the bulb 325 b isreplaced by an alternative pump, such as an electrically powered,pneumatic pump. The electric pump may be controlled remotely through acomputer system or other device.

A birthing device 326 is disposed inside the torso 316, as will bedescribed. The cover 324 is designed to obscure the fetal simulator 302of the simulator and the birthing device 326 from view, thus moreaccurately simulating the child birthing process, and challenging theuser's diagnostic abilities. With the stage 325 removed, the birthingdevice 326 may be operated via a manual crank (not shown), or by a smallmotor 326 a connected via a line 326 b to controlling means for turningthe motor on or off, as well as determining operational speed.

In a first embodiment, software of the program 15 a controls thebirthing device 326, as will be discussed in conjunction with FIG. 14,below. In an alternative embodiment, the controlling means is a controlbox 328, and a line 330 which connects the control box 328 to the CIM16. Referring to FIG. 5 b, the control box 328 has controls 328 a-d forrespectively turning the simulator 14 on and off, pausing and resumingchild birthing, determining the speed of the delivery rate, and settingthe fetal heart rate.

Referring to FIGS. 6 and 7, the torso 316 of the maternal simulator 300is shown with the cover 324 removed to expose the fetal simulator 302.The fetal simulator 302 is disposed in a cavity 333 of the maternalsimulator 300, and has a head 334, an attached torso 336, with a pair ofarms 338 a-b and legs 340 a-b attached to the torso. The head 334 issoft to allow for vacuum extraction, and has a mouth and nose which maybe suctioned by the user.

In that regard, in some embodiments the fetal simulator 302 includesforce sensors (not shown) positioned in the neck, shoulders, and hips tomonitor the amount of force being applied on the fetal simulator duringdelivery. Pulling on the head 334 produces a signal from the necksensor. The amount of force is relayed to the user and/or instructor bya user interface. The user interface can include a graphical display oraudible signals. For example, the user interface may produce a bar graphindicating the amount of force being applied or the user interface maybeep or otherwise sound an alarm when the force exceeds a predeterminedthreshold, prompting the user to reduce the force being applied or try adifferent delivery method. In one embodiment, the maximum forcethreshold is approximately 40 lbs. of force. In one embodiment, thepreferred range of force is between approximately 17-20 lbs. of force.Shoulder dystocia is a potentially fatal situation wherein the shoulderof the fetus becomes lodged behind the maternal pubic bone. Too muchforce can lead to brachial plexis and even Erb's palsy in the fetus. Tosimulate this potential situation, shoulder sensors are included at theleft and right shoulders of the fetal simulator 302 to monitor the forcebeing applied at the shoulders. Finally, various situations, such asvaginal breeches, can cause the legs 340 a-b to be grasped and removedfrom the vagina. The hip sensors serve to monitor the force beingapplied to the fetal simulator 302 in such situations. In someembodiments, the sensors 30 are in communication with an output deviceoperable to provide output signal indicative of the measurement aparticular sensor is adapted to monitor. The output device may output aelectrical signal, wireless signal, or any other suitable output signal.

The umbilical cord and placenta 302 a-b (FIG. 4) are removed to simplifythe illustration, but it is understood that the placenta 302 b (FIG. 4)could be disposed in any number of common orientations, such as normalfundal, low placement, or placenta previa, and attached to the cavity333 with conventional removable fasteners. Likewise, the umbilical cord302 a (FIG. 4) could be presented to replicate various complications,and may house connecting lines to the fetal simulator 302 to allow anumbilical pulse to be felt by the user, or to convey electricity to thefetal simulator 302, if necessary.

A receiver 342 is disposed on the fetal simulator 302 to allow thebirthing device 326 to retain the fetal simulator. Other receivers,similar to the receiver 342, are contemplated on different portions ofthe fetal simulator 302, such as to simulate a breech birth, and as thefetal simulator 302 articulates, a variety of breech deliveries, such asfull, frank, and footling may be simulated.

The birthing device 326 has a projection 344 of a ram 346 whichcooperates with the receiver 342 of the fetal simulator 302 to retainthe fetal simulator. In some embodiments, the receiver 342 andprojection 344 are adapted for selective engagement such that the fetalsimulator 302 is selectively engaged with or released by the maternalsimulator 300. In the depicted embodiment, the ram 346 is driven by adrive system, including a small electric motor, gears, electronic logicto permit resetting, means to determine the position of the ram, and aforward and reverse function. The ram 346 proceeds down a set of tracks347 a-b, thereby translating the fetal simulator 302 out of the maternalsimulator 300.

The projection 344 of the ram 346 is rotatable, the birthing device 326thereby producing both rotational and translational movement of fetalsimulator 302, to simulate a realistic child birthing scenario, whereinthe fetus makes a turn to bring it to a normal nose down position ofcrowning, and it makes another turn after crowning to allow itsshoulders to better pass through the birth canal. In some embodiments,the receiver 342 is disposed in another portion of the fetal simulator,such as the head, neck, shoulders, arms, hips, and/or legs. Alternativeembodiments of the receiver 342 and projection 344 are discussed inrelation to FIGS. 24-27 below.

In one embodiment, levers 346 a-b of the ram 346, being operablyconnected to the projection 344, engage cams 348 a-b, respectively, toproduce rotation. As the ram 346 proceeds down the tracks 347 a-b, thelevers 346 a-b of the ram engage the fixed cams 348 a-b in turn, causingthe respective lever to move. Movement of the lever rotates theprojection 344. Eventually, the respective lever is moved to a pointwhere the lever clears the respective cam. It can be appreciated thatthe cams 348 a-b may be located at places along the tracks 347 a-b whererotation is desired, the tracks simulating the birth canal. Thus,internal rotation of the fetus is produced by the lever 346 a engagingthe cam 348 a, and external rotation of the fetus is produced by thelever 346 b engaging the cam 348 b. As described below in relation toFIG. 28, in some embodiments the cams 348 a-b are moveable between aposition for causing rotation of the fetal simulator and a position thatdoes not cause rotation of the fetal simulator. Further, in someembodiments the cams 348 a-b include intermediate position(s) to providesome rotation to the fetal simulator. Alternatively, the program 15 aallows for adjustment of the rotation of the projection 344 from zero toone hundred and eighty degrees, as will be discussed with reference toFIG. 14, below. In either embodiment, the fetus 302 passes through adistensible cervix 350, as will be described.

Referring now to FIGS. 8 and 9, the distensible cervix 350 comprises aring 352 having attached flaps 353 a-b for maintaining the cervix'sposition in the cavity 333. As such, the flaps 353 a-b may have attachedsnaps, hook and loop closures, or other reversible fastening means. Awall 354 is connected to the ring 352, and is preferably of an elasticmaterial, such as Lycra⁷, or thermoplastic elastomer. A gathering 356 ofthe wall material defines a port 358. The gathering 356 may have anassociated elastomeric element disposed interiorly to enhance theelasticity of the port 358. Alternatively, the wall 354 itself mayprovide sufficient elasticity.

The port 358 expands from about two to ten centimeters in diameter asthe fetal simulator 302 is pushed through the port, and because of theshape of the fetal simulator's head 334, and the elasticity of the wall354, dilation is automatically simulated coincident to fetal descent.The user may then practice measuring cervical dilation and plot laborprogress as a Partograph. The elasticity of the wall 354 may beadjusted, for example by using thicker or thinner wall material, toproduce a cervix having faster or slower dilation than normal,respectively. The cervix 350 is disposed concentric to the pelvic area320, which has a pubic bone 360, as well as several cover snaps 324 a.

The fetal simulator 302 moves through the cervix 350 and out of thecavity 333 past vulva 362. The vulva 362 are made of a flexible materialso that the user may manipulate the vulva, or perform an episotomy tobirth the head 334. It is understood that the vulva 362 may comprise aportion of an insert (not depicted) including features such as a urinarytract and rectum, which could be replaceable with other genital insertsfor displaying various patient conditions. After delivery, the user maypractice postpartum exercises, such as massaging a uterus insert (notdepicted) back to a desirable size, removing retained placenta parts(not depicted), or repairing the cervix 350 or vulva 362.

In one embodiment, the torso 316 contains a simulated heart, lungs, andribs. The heart (not depicted) beats by the action of a pulsatile flowwhich is controlled by the program 15 a in response to the condition ofthe patient and upon therapeutic interventions. Palpable pulses may befound at carotid, brachial, radial, femoral, and pedis dorsis locations.Specific pulse locations become non-palpable as the systolic pressurefalls, and the absence or presence of a pulse will depend upon thesimulated blood pressure. Heart sounds are heard at appropriatelocations through the use of the stethoscope 12 j. The heart beat issynchronized with the Virtual EKGs, which are determined by the program15 a. Application of the stethoscope 12 j to a point below the BP cuff30 d (FIG. 2) will cause the appropriate Korotkoff sounds to be heard.

The maternal simulator 300 displays a combination of ventilation means,and lung and airway sounds are heard at appropriate locations using thestethoscope 12 j. The simulator 300 breathes spontaneously in a mannerthat would achieve targeted arterial blood gases for a given situation,including response to interventions such as ventilation andadministration of drugs, and demonstrates the amount of chest riserelating to the tidal volume and physiologic states. Normal gas exchangelung dynamics are virtual and are controlled by the program 15 a, whichmay also determine tidal volumes (TV), functional residual capacity(FRC), and expired carbon dioxide (CO₂). Airway resistance, lung andchest wall compliance are also controlled by the program 15 a.

The heart and lungs are connected to pressure transducers confirmingairway ventilation and cardiac compression. For example, an air line maybe mounted in tracheal wall or lungs of the simulator 300 and connectedto a sensor circuit connected to the CIM 16 so that when cardiopulmonaryresuscitation (CPR) ventilation is performed on the simulator, the CIM16 monitors the timing and magnitude of the pressure and volume of theventilation procedure, via the air line and the sensor. Similarly, acompression bladder may be embedded within the heart or chest cavity ofthe simulator 300 for sensing and confirming proper timing and magnitudeof a CPR chest compression procedure, when connected by an air line to acompression sensor circuit attached to the CIM 16. It can be appreciatedthat compression and ventilation data is acquired from pressure wavessensed by the CIM 16 through the lines 36. The blood pressure, heartrate, and oxygen saturation is virtually measured by the BP cuff 30 d(FIG. 2) and the Pulse Ox cuff 30 e (FIG. 2), although the datadisplayed is generated by the program 15 a.

Referring to FIG. 10, a neonate simulator 302′ may be used to replacethe fetal simulator 302 (FIG. 8) to allow practice of neonatalresuscitation according to the program 15 a. In other embodiments, thefetal simulator 302 is itself used in post-birth simulations. In thatregard, the fetal simulator 302 can have all of the functionalities andfeatures of the neonate simulator 302′ as described herein. The neonate302′ has a head 370, with hair 372, eyes 374 a-b, a nose 376, and amouth 378. The head assembly contains a realistic airway (not depicted)capable of accepting conventional airway adjuncts and a sensor fordetermining whether an airway adjunct has been placed, or whether afluid has passed. The head 370 is connected via a neck 380 to a torso382.

Sensors, generally denoted 30 (FIG. 1 a), may be disposed on the skin ofthe neonate simulator (shown as stippled) and/or beneath the skin (shownin phantom). Lines 36″ protrude from the torso 382 for providingelectrical, pneumatic, or fluid connection, as well as for connectingsensors (not depicted) to the CIM 16. The torso 382 has an umbilicalsite 384, which provides a site for catheterization, and a simulatedheart, lungs, and ribs for performing CPR. The heart and lungs areconnected to pressure transducers as described above for the maternalsimulator 300 for confirming airway ventilation and cardiac compression.The neonate simulator 302′ exhibits many of the same features as thematernal simulator 300 (FIG. 6), including heart rate, pulse,oxygenation, and a variety of body sounds which can be detected usingthe stethoscope 12 j (FIG. 2) or a conventional stethoscope. A pair ofarms 386 a-b, and a pair of legs 388 a-b, are also connected to thetorso 3382.

In one embodiment, the hands and feet as well as the face and uppertorso change color based upon proper oxygenation or an oxygen deficit.As oxygenation decreases, the extremities (peripheral cyanosis) changecolor first, followed by the face and upper torso (central cyanosis).Such change is reversible as oxygenation is improved.

In a preferred embodiment, coloration is achieved using bluethermochromatic dye (such as Reversatherm Blue Type F, available fromKeystone, Chicago, Ill.), approximately 3 grams dissolved in 10 grams ofclear vinyl paint thinner, and dispersed into 300 grams of clear vinylpaint. The mixture is applied to the hands, feet, chest, and face. Atroom temperature, the neonate is blue. Resistance heaters (such asavailable from Minco Products, Minneapolis, Minn.) are connected inparallel, and placed under the skin to provide 5-15 watts/in², or heatenergy sufficient to raise the surface temperature of the skin to about115°, causing the bluish color to disappear. Power for the heater issupplied through the CIM 16. The peripheral and central heaters may beseparately controlled to allow peripheral cyanosis without centralcyanosis. Heat sinks may also be disposed with the heaters to allowfaster cooling, and hence, faster changes in coloration.

In one embodiment, the thermochromatic system is logically linked to theprogram 15 a, for example, an instructor defines the condition of theneonate. Afterwards, coloration is responsive to CPR quality beingperformed by a user, either improving, worsening, or remaining the same.The program 15 a also provides for an override if coloration changes arenot desired. Coloration may alternatively be simulated by having applieda conventional photochrome to the simulator, such that upon exposure toan associated adjustable UV light, the simulator appears to turn blue.As another alternative, the coloration may be simulated by using coloredlights. For example, in one aspect blue LEDs can be used.

As mentioned above with respect to the maternal simulator, in someembodiments the neonatal simulator does not include lines 36″. Ratherthe neonatal simulator is tetherless such that is has self-containedfunctionality without the need for wired, tubed, or other physicalconnection to external devices.

Referring now to FIG. 11, a child birthing system 500 illustrates theuse of the foregoing embodiments. The simulator 14, for example, thematernal simulator 300 and fetus 302 are placed on a table 502.Students, W, X, Y, and Z, take places around the table, for example, Wcontrols medication, Y controls virtual instruments 12, X controlsanesthesia, and Z controls obstetrics. The child birthing device 326, asdiscussed above, may be driven via a manual crank or by a small motor326 a connected to either a control box 328, or the program 15 a of thecomputer 15 may optionally (shown in phantom) control the birthingdevice 326. Whichever controlling means are used, the distensible cervixaccurately reflects progress of the fetal simulator down the birthcanal. Eventually, as described above, the fetal simulator is birthed.

Once the fetal simulator is birthed, a team W′, X′, and Y′ (which areunderstood to be the same students W, X, and Y, or others depending onclass size) moves along path 1 to practice neonatal care on a table502′. At least one team, denoted by the absence of Z, must remain behindwith the maternal simulator for monitoring and potential stabilization.The fetal simulator is switched with a neonatal simulator 14′, forexample, neonatal simulator 302′ (FIG. 10). If connected to thecomputer, the program 15 a may be used to simulate the need for neonatalresuscitation, and CPR and other emergency care protocols may beperformed. The program 15 a monitors the care received by the simulatorvia the CIM 16 and virtual instruments 12, and compares the care toaccepted standards.

Meanwhile, the program 15 a of the computer 15 may be used to simulatethe need for maternal resuscitation. If so, a team moves along path 2 topractice maternal care on a table 502″. Students, W″, X″, Y″, and Z canwork on the maternal simulator 14″, for example maternal simulator 300with the fetal simulator removed. CPR and other emergency care may begiven, and the program 15 a monitors the care received by the simulatorvia the CIM 16 and virtual instruments 12.

Referring now to FIG. 12, an introductory screen display 400 of theprogram 15 a is presented on the computer 15 for teaching patient careprotocols to a user. The display 400 includes several decorativefeatures: a title box 402, a fetal heart rate box 404, a maternalintrauterine pressure box 405, a vital signs box 406, and an ultrasoundvideo box 407. The display 400 also contains a teaching box 408, atesting box 410, and a virtual instruments box 412. As will bedescribed, in some modules, the program 15 a compares informationpertaining to the user's activity with predetermined standards.

The screen 400 also displays a group of selectable patient care modules414 a-p provided by the program 15 a, which furnish information onmedical topics and associated concepts. Each module has a single topic,and represents an interactive patient care training session for theuser. The modules 414 a-g are disposed in the teaching box 408, and givean overview of relevant physiology, pregnancy, complications, labor andbirth, postpartum, and maternal and neonatal resuscitation protocols.The modules 414 h-j are disposed in the testing box 410, and give anopportunity to test a user in maternal and neonatal resuscitationprotocols, as well as instructor defined protocols (Codemaker). An exitbutton 415 for exiting the program 15 a is also disposed in the testingbox 410. The modules 414 k-p are disposed in the virtual instrumentstutor box 412, and give a user a tutorial on use of the system,including automatic birthing, fetal ultrasound, fetal distress monitor,vital signs, Partographs, and heart and lung sounds.

Referring to FIG. 13, if one of the modules (FIG. 12) is selected by theuser, such as by voice recognition or selection with a mouse of thecomputer 15, the program 15 a displays a display screen 416. The displayscreen 416 contains an information box 418, which contains topicalinformation. The display screen 416 also has a menu bar 420 containinginformation items (illustrated as A-D for convenience) listinginformation categories specific to the topic of the selected module. Itis understood that an item may be selected from the screen 416 via themenu bar 420, and that each module 414 a-p has its own display screenwith its own menu of specific informational items A-D, which may beexpanded to include a large number of items, or condensed for example,by placing selectable sub-items under an item.

Selection of an item from a menu, other than an exit item, causes textand/or illustrations topical to the selected menu item to be displayedin the information box 418. In practice, the program may generate a newdisplay screen (not depicted). As such, it is understood that theinformation screen 416 is used as an example of any number of screens,and furthermore, such screens can be displayed in sequential order, or aseries, for each item. A series of screens, such as screen 416,comprises a tutorial regarding patient treatment protocols for theselected menu item. Thus, the user can review information from a libraryof topics by selecting the appropriate module, and item, and thennavigating through a series. Navigation in a series of screens isattained by the user's selection between three boxes: 422, 424, and 426,respectively “Back”, “Next”, and “Exit”, with corresponding functionamong the screens, such as proceeding backwards or forwards in theseries. If no “Back” or “Next” function is possible, as respectivelywould be the case of the first and last screen of a series, the boxes422 or 424 may be unselectable.

For example, modules 414 f and 414 g, each engender a series to teach auser about maternal and neonatal resuscitation, respectively. The usermay also practice CPR on the simulator 14 (FIG. 1 a), such as thematernal simulator 300, or the neonatal simulator 302′, above, and theprogram 15 a senses the user's compression and ventilation, via the CIM16 (FIG. 1 a) and sensors 30 (FIG. 1 a). The heart and lungs of thesimulator 14 are connected to pressure transducers confirming airwayventilation and cardiac compression; for example, an air line may bemounted in tracheal wall of the simulator 14 and connected to a sensor30 connected to the CIM 16, so that when CPR ventilation is performed onthe simulator, the CIM 16 monitors the timing and magnitude of thepressure and volume of the ventilation activity, via the air line andthe sensor. Similarly, a compression bladder may be embedded within thechest cavity of the simulator 14 for sensing and confirming propertiming and magnitude of a CPR chest compression procedure, whenconnected by an air line to a compression sensor 30 attached to the CIM16. The program 15 a compares the information pertaining to the user'sactivity with predetermined standards, and thus provides an interactivetraining session.

The predetermined standards are selectable, and reflect medicalprotocols used around the world, including BLS and ACLS guidelines setforth by the American Heart Association and others. At least seven majorprotocols for cardiopulmonary resuscitation (CPR) are stored andselectable by the user. Moreover, a user may update the protocols, orenter and store a “New Protocol” reflecting the local protocol regardingdepth, duration, and frequency of cardiac compressions and airwayventilations. The program will use this series of acceptable limits togenerate a new CPR waveform for testing CPR.

Referring back to FIG. 12, selection of a test module 414 h-j from thetest box 410 directs execution of the program 15 a to provide a testingsequence to help test the user on patient care protocols, such asmaternal and neonatal resuscitation, and other responses to emergencyscenarios. The program 15 a paces through the steps of a patientdistress scenario, giving the user a predetermined time to respond orcomplete the task required, thus enabling the user to experience thepressure of a emergency situation. For example, the program 15 a maytest the user by presenting choices from which the user must select inorder to treat the patient, wherein the user must complete the correctchoice before the sequence proceeds to the next event. The program 15 aenables the user to enable, disable, or check the virtual instruments 12and sensors 30 for connection to supply input to the CIM 16.

If the virtual instruments 12 (FIG. 2) are enabled, the user mayimplement patient care activity on the simulator 14 using the virtualinstruments 12, while having the results and quality of response beingmonitored by the program 15 a. Alternatively, the user may usesoftware-simulated instruments 12′ (FIG. 1 b) generated by the program15 a. The program 15 a advances through the scenario until the patientrecovers, and provides a running critique of the user's responses, withan explanation of each incorrect choice or action. Features of the testmodules 414 h-j include items that enable the user to specify thataction sequences prescribed by the scenario comprise a predeterminednumber of compression/ventilation cycles on the simulator 14, or toallow the user to record the time and magnitude of the compression andventilation activity performed on the simulator 14, or to select among agroup of choices for hearing realistic sounds.

Testing may be defined by the program 15 a, as above, or by the user.For example, selection of the Codemaker Test module 414 j (FIG. 12)allows a first user, for example, an instructor, to create a scenario totest a second user, for example, a student. The first user may inputpreliminary data to define the patient simulator of the testing scenarioby entering a set of preliminary patient parameters regardinginformation such as sex, weight, and age, as well as patientindications, vital signs and cardiac rhythms which will be realisticallyreflected in the vital signs monitor 406 (FIG. 12). An instructordefined testing system allows the instructor to test the student onlocal, national, or international patient care protocols. Manyalgorithms are selectable by opening files, including BLS, ACLS,Pediatric, and Obstetric (OB) emergencies. Other algorithms may becreated and stored, and algorithms may be linked together as well.Benefits of this module include flexibility for instruction and theability to detect mastery of the subject. An instructor-definedalgorithm would presumably vary from well-known, structured algorithms,and thus avoid the problem of rote memorization of responses by thestudent.

Action may be taken in response to the conditions by the student, forexample, the student may select among virtual instruments to use torender patient care activities. The student may then perform the patientcare activities virtually, or using the tangible simulator.

Use of the modules 414 k-p of the virtual instruments tutor box 52provides information about instruments commonly used in child birthingscenarios. In some instances, opportunities to practice using some ofthe virtual instruments 12 in patient care protocols with the simulator14 are provided.

Turning now to FIGS. 14 and 15, the entire child birthing process may beautomated via the program 15 a, with the user merely defining initialconditions, such as delivery time 430, delivery profile 432, andcontraction intensity 434. The warp feature allows a full delivery to becondensed from 16 hours to 5 minutes. Child birthing then consists ofplacing the fetal simulator 302 on the projection 344, and placing thecover 324 on the maternal simulator 300. The program 15 a also offers avarying rate for progress of the ram 346, i.e., the first fewcentimeters may proceed much more slowly than the last few centimetersto better simulate child birth.

Referring to FIG. 16, if module 414 m (FIG. 12) is selected, a series ofscreens are shown regarding the fetal distress monitor, with tutorialinformation. An exemplary fetal distress monitor box 436 is depicted,along with a selectable On button 436 a for turning on the monitor. Thefetal distress monitor 12I cooperates with the simulator 14, the fetalheart monitor is placed on the cover 324 of the maternal simulator 300(FIG. 5 a) and interacts with at least one sensor 30, while thecontractions monitor interacts with another sensor 30 disposed on thecover.

Referring to FIG. 17, a neonate simulator 600 may be used to replace thefetal simulator 302 to allow practice of neonatal resuscitationaccording to the program 15 a. In one embodiment, the neonate simulatoris substantially the size of an average sized neonate of 28 weeksgestational age. In another embodiment, the neonate simulator 600 issubstantially the size of an average sized neonate of 40 weeksgestational age. The neonate simulator 600 exhibits many of the samefeatures as the maternal simulator 300, including heart rate, pulse,oxygenation, and a variety of body sounds that can be detected using thevirtual stethoscope 12 j or a conventional stethoscope. Further, asdescribed below the neonate simulator 600 is self-sufficient in that itdoes not require wired or tubed connection to any external devices forproper operation its numerous features, such as bulky externalcompressors and power supplies. The neonate simulator 600 is portable.In some embodiments the neonatal simulator is tetherless, such that itis functional without wired, tubed, or other physical connection toother external devices.

The neonate simulator 600 has a head 602, with hair 604, eyes 606 and608, a nose 610, and a mouth 612. The head 602 is connected via a neck614 to a torso 616. The torso 616 includes an umbilical site 618 thatprovides a site for catheterization. The torso 616 also includes aninterchangeable genetalia site 620 that is adapted to receive both maleand female genetalia pieces (not shown). Two arms 622 and 624 areconnected to and extend from the upper portion of the torso 616. Twolegs 626 and 628 are connected to and extend from the lower portion ofthe torso 616.

Sensors, generally denoted 30, may be disposed on the skin of theneonate simulator 600 (shown as stippled) and/or beneath the skin (shownin phantom) to provide various simulated features, as previouslydescribed. The torso 616 contains a simulated heart, lungs, and ribs forperforming CPR. In one aspect, the heart and lungs are connected topressure transducers as described above for the maternal simulator 300for confirming airway ventilation and cardiac compression. The torso 616also contains other components such as the power supply and wirelesscommunication devices. In one embodiment, the power supply is arechargeable pack of five lithium-ion cells. In one aspect, the powersupply is positioned in the area normally reserved for the liver.

To fit all of the functionality of the neonatal simulator 600 into amanikin the size of a neonate of 28 or 40 weeks gestational age, thenumerous electronics must be appropriately sized and preciselypositioned within the manikin where they are needed. In one embodiment,the electronic components of the neonate simulator 600 are grouped intosmaller modules based on function, rather than placed on a generalmotherboard. For example, FIG. 18 illustrates one possible set ofmodules 630 for use in the neonate simulator 600. The set of modules 630includes a master module 632 for interfacing the neonate 600 with thecomputer; a module 634 for generating the ECG signal; a module 636 forgenerating sounds such as heart, lungs, voice, and Korotkoff sounds; amodule 638 for sensing pressure such as chest compression, airwayventilation, blood pressure, and compressor pressure; a module 640 formonitoring intubation; a module 642 for driving valves and LEDs; amodule 644 for providing a connection such as a wireless interface andUSB-RF interface; a module 646 for producing voice sounds; and a module648 for producing sounds other than voice. One or more of these modules632-648 can be combined to create any number of simulation features forthe neonate simulator 600.

Referring to FIG. 19, the neonate simulator 600 includes a realisticairway 650 accessible via the mouth 612 and nose 610. The airway 650 iscapable of accepting conventional airway adjuncts and a sensor, such asmodule 640, is positioned adjacent the airway for determining whether anairway adjunct has been placed, or whether a fluid has passed throughthe airway. In one embodiment, the module 640 is an optical sensor thatmonitors the position of an airway adjunct, such as an endotrachialtube, and determines the adjunct is positioned too high, too low, orjust right. The neonate simulator 600 also includes a simulatedesophagus 652 that extends into the torso 616 to a simulated stomach.

Referring to FIG. 20, the neonate simulator 600 also includes an airsupply system 654 to simulate breathing, pulse, and associatedphysiological conditions of the neonate. The air supply system 654includes a muffler 656, a compressor 658 (that may be a single diaphragmcompressor such as model T2-03-E, available from T-Squared Pumps of NewJersey), a check valve 660 (appropriate valves may be obtained from GulfControls of Florida), a compressor controller 662, a primary accumulator664, and a secondary accumulator 666. The compressor can alternativelybe a rotary compressor or other suitable compressor.

In operation, the air supply system 654 provides pressured air to theneonate simulator 600 as follows. Air from the atmosphere 668 or areservoir enters the compressor through the input muffler 656. Thecompressor controller 662 is utilized to maintain the pressure in theprimary accumulator 664. A check valve 660 ensures air flow is in theproper direction. A pressure regulator (not shown) can be used tomaintain a predefined pressure in the secondary accumulator. The primaryand secondary accumulators are connected to actuators of the neonatesimulator 600 for controlling supply of air. In one embodiment, theprimary accumulator is connected to an actuator for controlling thesupply of air to airway 650. In one embodiment, the secondaryaccumulator is connected to an actuator for controlling the supply ofair to the lungs. The compressor controller 662 selectively providespower to the compressor 658 to maintain the desired pressure in theprimary accumulator 664. In one embodiment, the approximate desiredpressure of the primary accumulator is between 4.5-5.5 psi and theapproximate desired pressure of the secondary accumulator is 1.5 psi. Insome embodiments the air supply system 654 is further connected to thesimulated circulatory system to provide simulated pulses or otherwisefacilitate the simulated circulatory system.

The components of the air supply system 654 are positioned, insulated,and muffled to minimize the noise produced by the system. Since userswill be utilizing stethoscopes to assess heart and breathing sounds ofthe neonate simulator 600, excessive noise from the air supply system654 can interfere with and distract the user. To this end, portions ofthe air supply system 654 may be stored in the head 602 and extremities(arms 622, 624 and legs 626, 628) of the neonatal simulator 600.

For example, in one embodiment the compressor 658, the check valve 660,and the compressor controller 662 are positioned in the head 602 and themufflers and accumulators are positioned in the legs 626, 628. The noisecreated by the components in the head is shielded by a sound dampeningenclosure 672, illustrated schematically in FIG. 20. In one embodiment,the sound dampening enclosure 672 is a bilayer system having a firstlayer serving as an acoustic barrier and a second layer serving as amass barrier. In one aspect, the acoustic barrier and the mass barrierare formed of noise abatement materials from EAR Specialty Composites.Further, the exhaust air created by the compressor 658 is ported downinto legs 626, 628 of the simulator 600. Each leg 626, 628 includes amuffler system and an air reservoir. The muffler system dampens the“noisy” exhaust air to provide the air reservoir with a supply of“quiet” air for use by the neonate simulator 600 for the breathing andpulse simulations. In one aspect, the legs 626, 628 themselves serve asthe air reservoirs and are sealed to prevent leakage.

FIG. 21 shows an exemplary embodiment of a muffler system 674. Themuffler system 674 has three separate portions 676, 678, and 680 thatdampen the sound from the noisy air. Each portion 676, 678, 680 has afirst layer 682, 682, and 686, respectively, that serves as an acousticbarrier and a second layer 688, 690, and 692, respectively, that servesas a mass barrier. In one aspect, the acoustic barrier and the massbarrier are formed of the same noise abatement materials from EARSpecialty Composites as the sound dampening enclosure 672 describedabove. The noisy air is ported into the muffler system through a tube694. The quiet or dampened air then exits the muffler through a tube696. In one embodiment, the each leg 626, 628 is lined with noiseabatement material in addition to the muffler system to further muffleand dampen any noise.

In one embodiment the hands and feet as well as the face and upper torsochange color based upon proper oxygenation or an oxygen deficit. Asoxygenation decreases, the extremities (peripheral cyanosis) changecolor first, followed by the face and upper torso (central cyanosis).Such change is reversible as oxygenation is improved. In one embodiment,the amount of time the neonate is without oxygen determines where thecolor and corresponding vital signs start, and the effort that isrequired to successfully bring the neonate back to healthy condition. Insome embodiments, the simulator includes a mechanism for independentlychanging the color of the central portion and the peripheral portions.The mechanism, in some embodiments, utilizes blue LEDs or other lightingto simulate cyanosis.

In one embodiment, the thermochromatic system is logically linked to theprogram 15 a, for example, an instructor defines the condition of theneonate. Afterwards, coloration is responsive to CPR quality beingperformed by a user, either improving, worsening, or remaining the same.For comparison, an adult can tolerate between 5-10 minutes withoutoxygen. A pregnant mother or the maternal simulator 300 uses oxygen morequickly than a normal adult and, therefore, is affected more quickly. Aneonate, on the other hand, can tolerate on the order of 15 minuteswithout oxygen, with death in about 30 minutes. Thus, if the hypoxicevent is 5-7 minutes the neonatal simulator 600 will “pink up” rathereasily. If the hypoxic event is 12-15 minutes then recovery will beslower and requires more effort on the part of the user. Further, if thehypoxic event is more than 20 minutes, then it is very difficult evenwith the use of epinephrine for the user to get the neonatal simulator600 to “pink up,” and the neonatal simulator 600 can die or suffer somelifelong malady, such as cerebral palsy.

In one embodiment, the instructor can select the degree of cyanosis ofthe neonatal simulator 600, as shown in the screen display 700 of FIG.22. Though not shown in the screen display 700, the instructor may alsoselect or define various other attributes of the neonatal simulator 600,such as the muscle tone in the arms 622, 624 and the legs 626, 628(e.g., limp, well-flexed, motion, etc.) and the “speech” of the neonatalsimulator 600 (e.g., crying, grunting, stridor, etc.). The vital signsand recovery of the neonatal simulator 600 can be monitored using adisplay 702, as shown in FIG. 23. The program also provides for anoverride if coloration changes are not desired.

Referring now to FIGS. 24-27, shown therein is an engagement system 740that is an alternative embodiment to the receiver 342 and projection 344system for selectively engaging the fetal or neonatal simulator 302, 600to the maternal simulator 300. The engagement system 740 includes amechanism 742 that engages a mechanism 744. In some embodiments, themechanism 742 is disposed within the fetal or neonatal simulator 302,600 and the mechanism 744 is disposed within the maternal simulator 300.In one embodiment, the mechanism 742 is adapted to replace the receiver342 and the mechanism 744 is adapted to replace the projection 744. Inother embodiments, the mechanism 742 is disposed within the maternalsimulator 300 and the mechanism 744 is disposed within the fetal orneonatal simulator 302, 600.

Referring more specifically to FIG. 25, the mechanism 742 includes ahousing 745 with a opening 746 extending therethrough. In the currentembodiment the opening 746 is centrally located and substantiallycylindrical. In other embodiments, the opening 746 can have variousother cross-sectional shapes, including polygon, irregular, and othershapes. The mechanism 742 also includes a locking portion 748. Thelocking portion 748 and housing 745 can be permanently secured together(e.g. glued) or temporarily secured together (e.g. threaded engagement).Further, the locking portion 748 and/or the housing 745 may includeadditional features not shown to facilitate the engagement between thetwo pieces. In other embodiments the housing 745 and the locking portion748 are an integral piece.

As shown in FIG. 26, the locking portion 748 includes a body portion749. The body portion 749 is adapted to mate with the opening 746 of themechanism 742. Thus, in the current embodiment the body portion 749 issubstantially cylindrical, but in other embodiments may have othercross-sectional shapes to match opening 746. The locking portion 748further includes an actuator 750 for moving locking pins 752 from anextended position, shown in FIG. 26, to a retracted position. In oneembodiment the retracted position of the locking pins 752 issubstantially within the body portion 749 of the locking portion. Asdescribed below, the selective extension and retraction of the lockingpins 752 causes selective engagement of the mechanism 742 with themechanism 744. In this manner the fetal and neonatal simulators 302, 600are selectively engaged with the maternal simulator 300. In someembodiments, the actuator 750 is selective actuated by a solenoid. Insome embodiments, the solenoid is disposed within the fetal or neonatalsimulator 302, 600 or maternal simulator 300 adjacent the actuator 150.In some embodiments, the solenoid is located within the mechanism 742.In some embodiments, the solenoid is actuated via wireless device or acomputer system such that an instructor can selectively release thefetal or neonatal simulator.

Referring more specifically to FIG. 27, the mechanism 744 includes abody portion 754. In the current embodiment, the body portion 753 issubstantially cylindrical, but in other embodiments has othercross-sectional shapes. The mechanism 744 also includes an engagementportion 754. The engagement portion 754 has a substantially squarecross-sectional shape, but in other embodiments has othercross-sectional shapes. The engagement portion 754 further includes anopening 755 extending therethrough. The opening 755 is adapted toreceive the locking portion 748 of the mechanism 742. The engagementportion 754 also includes locking openings 756. The locking pins 752 ofthe locking portion 748 are adapted to engage openings 756 whenextended. When retracted, the locking pins 752 retract from the openings756 releasing locking mechanism 748 from the engagement portion 754.

Referring to FIG. 28, shown therein is a system for providing selectiverotation to the fetal or neonatal simulators 302, 600. The system isadapted to move the cam 348 a between a first position for causingrotation of the fetal simulator and a second position that does notcause rotation of the fetal simulator. In this manner the system can beused to selectively rotate or not rotate the fetal simulator during abirthing simulation. In some embodiments, retracting the cam 348 a to aposition adjacent the track 347 a prevents rotation of the fetalsimulator. In some embodiments, the cam 348 a is further moveable to anintermediate position that causes some rotation of the fetal simulator,but less rotation than the first position. In some embodiments, the cam348 a is moveable between a plurality of intermediate positions eachallowing a different amount of rotational movement. In some embodiments,the plurality of intermediate positions and the amount of rotation arecontinuous. In other embodiments, the plurality of intermediatepositions and the amount of rotation are discrete.

The system includes a solenoid 760 that is adapted to selectivelyretract the cam 348 a. The solenoid 760 is a connected to the cam 348 avia an extension 761 and a fixation member 762. In one embodiment, thefixation member 762 is a bolt, screw, other threaded member, or otherdevice for connecting the cam 348 a to the extension 761. The cam 348 ais connected to track 347 a via fixation members 764 and 766. Thefixation members 764 and 766 in some embodiments are bolts and nuts. Thefixation members 764 and 766 also serve to prevent unwantedtranslational and rotational movement of the cam 348 a with respect totrack 347 a. In other embodiments, the cam 348 a and solenoid 760 may beadapted to translate along the track 347 a. Further, in some embodimentsthe cam 348 a may be adapted for rotational movement with respect totrack 347 a. In some embodiments, the position of the cam 348 a iscontrolled remotely, and in some embodiments wirelessly, by theinstructor or computer program. Though the system has been describedwith respect to track 347 a and cam 348 a, the same system is applied totrack 347 b and 348 b.

Although illustrative embodiments have been shown and described, a widerange of modification, change, and substitution is contemplated in theforegoing disclosure and in some instances, some features of the presentembodiment may be employed without a corresponding use of the otherfeatures. It is understood that several variations may be made in theforegoing without departing from the scope of the embodiment. Forexample, the system 10 may be modified by simply modifying the program15 a and/or the virtual instruments 30 and sensors 30. Accordingly, itis appropriate that the appended claims be construed broadly and in amanner consistent with the scope of the embodiment.

1-33. (canceled)
 34. A simulation system for teaching patient care, thesystem comprising: a maternal simulator having: a body sized and shapedto simulate a pregnant woman; one or more simulated respiratorycomponents positioned within the body; one or more simulated circulatorycomponents positioned within the body; and a birthing device positionedwithin the body, the birthing device configured to interface with afetal simulator and configured to translate and rotate the fetalsimulator in a manner simulating a birthing sequence.
 35. The system ofclaim 34, wherein the one or more respiratory components includessimulated lungs.
 36. The system of claim 35, wherein the one or morerespiratory components includes a simulated airway extending within thebody from at least a simulated mouth of the maternal simulator.
 37. Thesystem of claim 34, wherein the one or more circulatory componentsincludes a simulated heart having a simulated heart rate.
 38. The systemof claim 37, wherein the simulated heart rate is synchronized with asimulated EKG.
 39. The system of claim 34, wherein the one or morecirculatory components facilitates measuring a simulated blood pressurein at least one arm of the maternal simulator.
 40. The system of claim34, wherein a speed of the birthing device is adjustable to modify alength of time of the birthing sequence.
 41. The system of claim 34,wherein the maternal simulator is tetherless.
 42. A simulation systemfor teaching patient care, the system comprising: a maternal simulatorhaving: a body sized and shaped to simulate a pregnant woman, the bodyincluding a simulated torso, simulated legs, simulated arms, and asimulated head; one or more simulated respiratory components positionedwithin the body; one or more simulated circulatory components positionedwithin the body; and a birthing device positioned within the torso ofthe body, the birthing device configured to interface with a fetalsimulator and configured to translate and rotate the fetal simulator ina manner simulating a birthing sequence.
 43. The system of claim 42,wherein the one or more respiratory components includes simulated lungs.44. The system of claim 43, wherein the one or more respiratorycomponents includes a simulated airway extending within the body from atleast a simulated mouth of the maternal simulator.
 45. The system ofclaim 42, wherein the one or more circulatory components includes asimulated heart having a simulated heart rate.
 46. The system of claim45, wherein the one or more circulatory components facilitates measuringa simulated blood pressure and the simulated heart rate in at least oneof the arms of the maternal simulator.
 47. The system of claim 41,wherein a speed of the birthing device is adjustable to modify a lengthof time of the birthing sequence.
 48. The system of claim 41, whereinthe maternal simulator includes a contraction mechanism for increasingthe hardness of a portion of the torso to simulate a contraction. 49.The system of claim 48, wherein the contraction mechanism is configuredto produce different levels of hardness in the portion of the torso tosimulate different levels of contraction strength.
 50. A simulationsystem for teaching patient care, the system comprising: a maternalsimulator having: a body sized and shaped to simulate a pregnant woman,the body including a simulated torso, simulated articulating legs,simulated articulating arms, and a simulated head; one or more simulatedrespiratory components positioned within the body, the one or moresimulated respiratory components including a pair of simulated lungs;one or more simulated circulatory components positioned within the body,the one or more simulated circulatory components configured to produce asimulated heart rate and simulated blood pressure; and a birthing devicepositioned within the torso of the body, the birthing device configuredto interface with a fetal simulator and configured to translate androtate the fetal simulator in a manner simulating a birthing sequence.51. The system of claim 50, wherein the birthing device includes amechanism for selectively engaging the birthing device with the fetalsimulator.
 52. The system of claim 51, wherein the fetal simulator isnot removable from the maternal simulator during birthing simulationwhen the mechanism is selectively engaged with the fetal simulator. 53.The system of claim 52, wherein disengagement of the mechanism with thefetal simulator is controllable by an instructor positioned remotelyfrom the maternal simulator.